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    Patent Pending

    PECARN Pediatric Intra-Abdominal Injury (IAI) Algorithm

    Identifies children at very low risk of clinically important blunt abdominal injuries.

    INSTRUCTIONS

    Use in patients <18 years old presenting with blunt abdominal trauma within 24 hours of injury. Do not use in patients with penetrating trauma, pre-existing neurologic disorders impeding a reliable exam, or pregnancy. Do not use in patients transferred from another hospital where abdominal CT or diagnostic peritoneal lavage was already performed.

    When to Use
    Pearls/Pitfalls
    Why Use

    • Patients <18 years old presenting with blunt abdominal trauma within 24 hours of injury. 

    • Do not use in patients with any of the following characteristics:

      • Penetrating trauma. 

      • Pre-existing neurologic disorders impeding a reliable exam.

      • Pregnancy.

      • Transfer from another hospital where abdominal CT or diagnostic peritoneal lavage was already performed.

    • Uses history and physical only (no labs or imaging).

    • Aspects of history may be difficult or unreliable in nonverbal or young children.

    • Patients with altered mental status or findings of abdominal wall trauma (bruising, abrasions, seat belt sign) are at highest risk for intra-abdominal injury.

    • Mandatory CT was not performed in all study patients for ethical reasons, so minor clinically silent injuries may be missed.

    • Six patients with IAI requiring intervention who were misclassified as very low risk, with the following mechanisms of injury: motor vehicle collision (4 patients), non-accidental trauma (1 patient), child struck by vehicle (1 patient).

      • All six had hemoperitoneum, four had splenic injury, two had kidney injury, two had intestinal injury, and one had liver injury.

      • Of the six injuries misclassified as low risk, five had laboratory abnormalities that implied intra-abdominal injury (hematuria, elevated liver enzymes).

      • Five of the six missed patients also had either distracting injury or alcohol intoxication.

    • May help rule out intra-abdominal injury from blunt torso trauma requiring acute intervention, with 97% sensitivity and 99.9% negative predictive value.

    • May decrease use of CT scan to assess for intra-abdominal injury as very low risk children may not need a scan.

      • Reducing use of CT scans in pediatric abdominal trauma can decrease risk of malignancy later in life, as exposure to ionizing radiation during childhood is associated with increased risk of malignancies over a lifetime.

    • Does not require laboratory or ultrasonographic information.

    • Found to be more sensitive than unstructured clinical suspicion in one study (Mahajan 2015).

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    Next Steps
    Evidence
    Creator Insights
    Dr. James F. Holmes

    About the Creator

    James F. Holmes, MD, MPH, is a professor in the department of emergency medicine at the University of California, Davis. He is the Vice Chair for Research and his research interests include pediatric trauma, head and spine trauma, and selective use of head CT. Dr. Holmes has been involved in the development of emergency medicine in several countries, including Fiji.

    To view Dr. James F. Holmes's publications, visit PubMed

    Are you Dr. James F. Holmes? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    Reviewed By
    • Julia Schweizer, MD
    About the Creator
    Dr. James F. Holmes
    Are you Dr. James F. Holmes?
    Content Contributors
    Reviewed By
    • Julia Schweizer, MD